A 35-year-old woman presents with fatigue, cold intolerance, weight gain, and failure of lactation 18 months after a delivery complicated by 2.5 litres of postpartum hemorrhage requiring transfusion. She has not resumed menstruation since delivery. Serum FSH is 2 IU/L, LH is 1.5 IU/L, estradiol is 15 pg/mL, and prolactin is undetectable. What is the most likely diagnosis?
- A Prolactinoma
- B Sheehan syndrome ✓
- C Primary hypothyroidism
- D Functional hypothalamic amenorrhea
Correct answer: B. Sheehan syndrome
Explanation
Sheehan syndrome is anterior pituitary necrosis from postpartum hemorrhage causing panhypopituitarism. The triad of failure of lactation, amenorrhea, and symptoms of hypothyroidism with low gonadotropins (FSH, LH) and low estradiol is classic. Prolactinoma would cause elevated prolactin. Primary hypothyroidism would show elevated TSH with normal or elevated prolactin. Functional hypothalamic amenorrhea does not cause undetectable prolactin or hypothyroid symptoms. (Williams Endocrinology; Harrison's Principles of Internal Medicine).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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